Penatalaksanaan Anestesi pada Koreksi Atresia Esophagus dan Atresia Esofagus
ABSTRACT
Background: Esophageal atresia is a congenital medical condition (birth defect) which affects the digestive tract. Congenital anatomical defect is caused by an abnormal embryological development of esophageal fistula forming tracheoesofageal. Surgical repair is the definitive treatment for EA and TEF. Due to fistula, the airway tract is altered and the anesthesiologist should face a unique challenge on its management
Case : A baby boy, admitted to hospital with main complaint vomitus after breastfed. Physical findings shown as crackles on breath sound. Intubation using awake technique. During operation, hemodynamic was stable, maintanance with sevoflurane MAC 1%, fentanyl 4 μg/hr, and rocuronium 0,5 mg/hr. When desaturation occured, we stop the operation, we check the tube in place, gave adequate ventilation, after a while the saturation rises and then the operation procedure continued. However, anastomose of esophagus could not be done because the distance between the defect was too far. Duration of the operation was about 4 hours. Awake intubation technique was used. Hemodynamic was stable during surgery, and found TEF type C. After surgery patient was taken cared in NICU and 3 days later the patient died.
Summary: Good anesthetic management using "awake intubation" and good ventilation is a chosen technique in this case. The operation lasted 4 hours with stable hemodynamics. However, because the operation did not successfully correct the defect, then the postoperative outcome were futile.
Keywords : Anesthesia management, congenital anomaly, tracheoesophageal fistula
ABSTRAK

Pendahuluan : Atresia esofagus adalah suatu kondisi medis bawaan ( cacat lahir ) yang mempengaruhi saluran pencernaan . Cacat bawaan anatomi disebabkan oleh perkembangan embrio abnormal fistula esofagus membentuk tracheoesofageal . Bedah perbaikan adalah pengobatan definitif untuk EA dan TEF . Karena fistula , saluran napas diubah dan ahli anestesi harus menghadapi tantangan unik pada manajemen

Kasus : Seorang bayi laki-laki , masuk rumah sakit dengan keluhan utama muntah setelah disusui . Temuan fisik ditemukan ronki basah kasar pada suara napas . Intubasi menggunakan teknik intubasi sadar . Selama operasi , hemodinamik stabil , maintanance dengan sevofluran MAC 1 % , fentanil 4 mg / jam , dan rocuronium 0,5 mg / jam . Durasi operasi adalah sekitar 4 jam . Hemodinamik stabil selama operasi , dan menemukan TEF tipe C. Ketika desaturasi terjadi , kami menghentikan sejenak operasi, kami memeriksa posisi ETTat , memberikan ventilasi yang cukup , setelah beberapa saat saturasi naik dan kemudian operasi dilanjutkan . Meski demikan anastomose esofagus gagal dilakukan karena jarak antara cacat itu terlalu jauh . Setelah pasien operasi diambil dirawat di NICU dan 3 hari kemudian pasien meninggal.

Ringkasan: Manajemen anestesi baik menggunakan " intubasi sadar " dan ventilasi yang baik adalah teknik yang dipilih dalam kasus ini . Operasi berlangsung 4 jam dengan hemodinamik stabil. Namun, karena operasi tidak berhasil memperbaiki cacat tersebut , maka hasil pasca operasi kurang baik.

Kata kunci : Manajemen anestesi, kelainan kongenital , fistula trakeoesofageal
Artikel Sekarang
Dipublikasi pada 01 November 2013
Penulis :
» Fadli Armi Lubis
» Hasanul Arifin
Kategori : Laporan Kasus
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Volume V Nomor 3, November 2013 Cover JAI
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